he paper demonstrates differential effects of a prospective payment system with declining per diem rates, dependent on the percentiles of length of stay. The analysis uses dynamic panel data estimates and a recent nationwide administrative database for major diagnostic categories in 1068 Japanese hospitals in 2006–2012 to show that average length of stay significantly increases for hospitals in percentiles 0–25 of the pre‐reform length of stay and significantly decreases for hospitals in percentiles 51–100. The decline of the average length of stay is larger for hospitals in higher percentiles of the length of stay. Hospitals in percentiles 51–100 significantly increase their rate of nonemergency/unanticipated readmissions within 42 days after discharge. The decline in the length of total episode of treatment is smaller for hospitals in percentiles 0–25. The findings are robust in terms of the choice of a cohort of hospitals joining the reform. The paper discusses applicability of ‘best practice’ rate‐setting to help improve the performance of hospitals in the lowest quartile of average length of stay.
Dishonest behavior significantly increases the cost of medical care provision. Upcoding of patients is a common form of fraud to attract higher reimbursements. Imposing audit mechanisms including fines to curtail upcoding is widely discussed among health care policy-makers. How audits and fines affect individual health care providers' behavior is empirically not well understood. To provide new evidence on fraudulent behavior in health care, we analyze the effect of a random audit including fines on individuals' honesty by means of a novel controlled behavioral experiment framed in a neonatal care context. Prevalent dishonest behavior declines significantly when audits and fines are introduced. The effect is driven by a reduction in upcoding when being detectable. Yet, upcoding increases when not being detectable as fraudulent. We find evidence that individual characteristics (gender, medical background, and integrity) are related to dishonest behavior. Policy implications are discussed.
Global health spending share of low/middle income countries its long-term growth. BRICS nations remain to be major drivers of such change since 1990-s.
Can self-assessments of health reveal the true health differentials between ‘rich’ and ‘poor’? The potential sources of bias include psychological adaptation to ill-health, socioeconomic covariates of health reporting errors and income measurement errors. We propose an estimation method to reduce the bias by isolating the component of self-assessed health that is explicable in terms of objective health indicators and allowing for broader dimensions of economic welfare than captured by current incomes. On applying our method to survey data for Russia we find a pronounced (nonlinear) economic gradient in health status that is not evident in the raw data. This is largely attributable to the health effects of age, education and location.
Mixed payment systems have become a prominent alternative to paying physicians through fee-for-service and capitation. While theory shows mixed payment systems to be superior, causal effects on physicians’ behavior when introducing mixed systems are not well understood empirically. We systematically analyze the influence of fee-for-service, capitation, and mixed payment systems on physicians’ service provision. In a controlled laboratory setting. We implement an exogenous variation of the payment method. Medical and non-medical students in the role of physicians in the lab (N = 213) choose quantities of medical services affecting patients’ health outside the lab. Behavioral data reveal significant overprovision of medical services under fee-for-service and significant underprovision under capitation, although less than predicted when assuming profit maximization. Introducing mixed payment systems significantly reduces deviations from patient-optimal treatment. Although medical students tend to be more patient regarding, our results hold for both medical and non-medical students. Responses to incentive systems can be explained by a behavioral model capturing individual altruism. In particular, we find support that altruism plays a role in service provision and can partially mitigate agency problems, but altruism is heterogeneous in the population.